Res. No. 144-97-10114RESOLUTION NO.144-97-10114
A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF
THE CITY OF SOUTH MIAMI,FLORIDA,RELATING TO
FACADE IMPROVEMENTS ON SOUTHWEST 59TH PLACE
AUTHORIZING AN APPLICATION TO THE METRODADE OFFICE
OF COMMUNITY AND ECONOMIC DEVELOPMENT (OCED)TO
REQUEST AN AWARD OF COMMUNITY DEVELOPMENT BLOCK
GRANT (CDBG)FUNDS IN THE AMOUNT OF $130,000.00
TOWARD CONSTRUCTION OF A FACADE ON PARTICIPATING
BUSINESSES AS A DEMONSTRATION PROJECT.
WHEREAS,TheimplementingrecommendationsofCharretteIIis
an objective of the City;and
WHEREAS,The construction ofa facade on businesses along SW
59th Place isa recommended activity;and
WHEREAS,fundingforthisactivitymaybeavailablethrough
Community Development Block Grant fund;
NOW THEREFORE BE IT RESOLVED BY THE MAYOR AND CITY
COMMISSION OF THE CITY OF SOUTH MIAMI,FLORIDA:
Section 1the City of South Miami is submitting the
application forfundingtotheOCEDforCDBGfundinginthe
amount of$130,000.00 toward Construction of Building Facade as
a demonstration project;
Section 2 This resolution shall take effect immediately
upon approval.
PASSED AND ADOPTED this 29th day of July,1997.
ATTEST:
Y CLERK
READ AND APPROVED AS TO FORM;
CITY ATTORNEY 7
COMMISSION VOTE:5-0
Mayor Price:Yea
Vice Mayor Robaina:Yea
Commissioner Oliveros:Yea
Commissioner Bethel:Yea
Commissioner Young:Yea
CITY OF SOUTH MIAMI
INTER-OFFICE MEMORANDUM
To:Mayor &Commission Date:July 25,1997
V*&J&£&/£&&'Subject:Agenda Item #l_From:L ^„*~„~~~-^c^r ^„.**>*-/
Commission MeetingJuly 29,1997
Application forFunding
An application has been prepared for submission to Metro Dade Office of Community and
Economic Development requesting $130,000.00 in Community Development Block Grant funds
for Design and Construction ofbuilding facade for buildings onthe East side of SW59th Place
between SW 68th and 69th Street.This isa demonstration project initially proposed in Charrette
II.This resolution authorizes submitting the application for funding.
ACTIVITY APPLICATION SUBMISSION
FOB^I FY 1998
1.Description(Activity No.2 of 3 )
Agency:City of South Miami
ThlstwojjaqefonnistobefiUedoutforeachactW
each funding source requested;If this foi^is incomplete.
Contact :•William Pratt
Agency Address:6130 Sunset Drive CSty:South Miami Zip Code:33143
Activity Title:Facade Improvement
Activity Description:Design and construct a facade for buildings on the east
side of SW 54th Place between SW SW 68th and feyth Street-
Z.Funding Information
Funding Source Requested:QCDBG 98 QHOME 98 QESG 98
Last Year's
FY98 Requested Amount $130,000.00 (FY97)Funding:$0.00
Is funding being received for this activity from
other sources?If so,list sources and amounts.
Attach letter(s)of commitment if available.
HIP 98D81 URTAX98•SI
Total Project
Cost:$130,000.00
3.Geographic Information
Activity Address:SW-59th Place between SW 68th and 69th Street
Ifa street address is unavailable,please
provide crossroads information.
Folio Number Census Tract 76.03 Block Group:
Isthis activity located inan Eligible Block Group or Focus Area?Ifnot,isitinan Entitlement City,Non-Focus Area,
CountywideorStateof Florida SmallCities CDBG Program activity?Pickonlyone.
^JCountywide
3ntitlement City
on-Entitlement City
Focus Areas:
^J.eisure City
^Coconut Grove
^JGoulds
Eligible Block Groups:
^Atlantic Blvd.
^JBiscayne Boulevard
^[Biscayne Lake Gardens
^jBunche Park
^]Carol City
Solphin Industrial Park
lagami Elementary
^pagami Park
^]FMC/St.Thomas
^Golden Glades
^[Multi-Focus Area
"HNon-Focus Area
^jMelrose
^JVIodel City
HOpa-locka
"HGolden Pond
^JLake Lucerne
"ILakeview
HMiami Gardens Drive
"HNaranja
^[Norland
^jNorth Central Dade
^JOIympia Heights
HPinewood/Kennel Club
Page 33
[^Florida Small Cities-Homestead
QFIorida Small Cities-Florida City
Perrine
1^South Miami
~lWest Little River
aimer Lake
ed Road Manor
ichmond Heights
^Sierra Estates
^|South Miami Heights
southland Pines
urfside
^jVista Verde
SUMMARY APPLICATION SUBMISSION FORM FY 1998
Instruction Sheet
2.Funding Information
Funding Source:Check funding sourcerequested.(Oneper activity).
FY98 Requested Amount Specifyamount requested forFY98.
FY97 Funding:IffundedinFY 97,specifyamount.
TotalProjectcost:Specifytotalamount required tocompletethe project.
Leveraging:Specifysourceandamountofother funding.Attachletter(s)of commitment.
3.Geographic Information
Activity Address:Specify Street Address.
Location:If street address is unavailable,please provide crossroads.
Area:Check appropriate option.
EnterpriseZone:Ifapplicable,please checkappropriate option.
District Check appropriate option.If a multi-district,specifywhichdistricts.
Census Tract Specify census tract.
Block Group:Specify blockgroup.
Folio Number Please provide the folio number for proposed site.
4.HUD Information
HUD Code:See following pages 3,4 and5 directly afterthis form.Check HUD activity typeand
activity code.
National Objective:Check appropriate option.
Proposed AccomplishmentType:Checkappropriateoption.
Proposed No.ofaccomplishments:Please specify.
Total units:For housing activities only,please specify the total number of units tobe constructed.
5.Metro -Dade Information
Metro-Dade Category:Check appropriate option.
AgencyType:Checkappropriate option.
Special needs groups:If applicable,please check appropriate option.
Please check the State Enterprise Zone or Federal Enterprise Community in which this activity is located.
jxjNot Applicable [""{Miami Beach [""^Federal Enterprise Community
PJNorth CentraljpHomestead/Florida City
For Economic Development activities only,please indicate the Targeted Urban Area which the proposed activity will serve.
["Richmond Heights [TCarolCity [""Little Haiti [TWV 27 Ave.Corr.QCoconut Grove [^Leisure City
rnperrine [""jGoulds [""ppa-Locka [""prownsville ["West Little River [xpouth Miami
["Model City/Liberty City [""JOvertown [~NW 183 St Corr.f^mstd/FL City .QPrinceton/Naranja
Which Commission District does this
activity serve?Check only one.
Exception:If Multi-District check
appropriate District box(es).
confer with <
Q570.208(a)(1)L/M Area Benefit
Q570.208(a)(2)L/M Limited Clientele
Q570.208(a)(3)L/M Housing Benefit
Proposed Accomplishment Type:
[^Businesses
QEIderly
[""plderiy Households
[""Feet of Public Utilities
Proposed No.of Accomplishments:
(Recipients)
5.Metro-Dade Information
Funding Category:
[HCapital Improvement
[^Economic Develoment
Agency Type:
[HCounty Department
[xjMuntcipality
nCountywide
^District 01
rTDistrict 02
FlDistrict 03
4.HUD Information
HUD Code and Eligibility Citation:Check the appropriate box on the next pages.
National Objective:
Note that 570.208 (c)Urgent Need is a very restrictive category that is not applicable to most proposed activities.Please
i OCED staff in order to determine the appropriate use of this category for your proposed activity.
[^District 04
r"|District05
[^District 06
["^District 07
Q570.208(a)(4)L/M Jobs Benefit
Q570.208(b)(1)S/B Area Benefit
Q570.208(b)(2)S/B Spot Benefit
HJHouseholds (General)
j""]Housing Units
P^Large Households
reorganizations
|""|Historic Preservation
QHousing
r]PuD|ic Service Provider-501(c)(3)
[""public Service Provider -For Profit
Is the proposed project utilizing property identified in the OCED Land and Public
Housing Disposition List?
If yes,is this a premium site?
Areanyof these special needs groupsbenefittingfromthisactivity?
•EUerly [^Mentally and Physically Disabled
rjFarmworker Agencies and Services ["persons with Aids
Qtomeless Agencies and Services QPersons withDrug or Alcohol Addictions
Page 34
[^District 08 '
QDistrict 09
[""[District 10
rnDistridH
Fpistrict12
["^District 13
Q570.208(b)(3)S/B Urban Renewal
Q570.208(c)Urgent Need
[""people (General)
["public Facilities
FTSmall Households
QTouth
Total Units:
(Housing Only)
["[Administration
FTPublic Service
[""[Developer -501(c)(3)
[""[Developer -For Profit
esIT'
•Yes
Jxpo
jxJNo
[~]Public Housing Residents
nWelfare/Wages
COMMUNITY DEVELOPMENT BLOCK GRANT EUGIBILITY ACTIVITY FORM
(Check only one for each activity /application.)
CHECK <CODE .ACTIVITY DESCRIPTION
01 Acquisition ofRealProperty
02 :Disposition
03 Public Facilities andImprovements (General)
03A Senior Centers
03B Handicapped Centers
03C Homeless Facilities (notoperatingcosts)
03D Youth Centers
03E Neighborhood Facilities
03F Parks,Recreational Facilities
03G Parking Facilities
03H SolidWasteDisposalImprovements
031 FloodDrainImprovements
03J Water/Sewer Improvements
03K Street Improvements
03L Sidewalks
03M Child Care Centers
03N TreePlanting
03O Fire Station/Equipment
03P Health Facilities
03Q Abused and Neglected Children Facilities
03R Asbestos Removal
03S Facilities for AIDS Patients(not operating costs)
03T Operating Costs ofHomeless/AIDS Patients programs
|04 Clearance and Demolition
04A Clean-up ofContaminated Sites
05 PublicServices (General)
05A Senior Services
0SB Handicapped Services
05C LegalServices
05D Youth Services
|05E {Transportation Services
tfa
17A CILandAcquisition/Disposition
17B CI Infrastructure Development
17C CIBuildingAcquisition,Construction,Rehabilitation
x 17D Other Commercial/Industrial Improvements
18A ED Direct Financial Assistance to For-Profits
18B ED Technical Assistance
18C Micro-Enterprise Assistance
19C CDBG Non-profit Organization Capacity Building
19D CDBG Assistance toInstitutes ofHigher Education
19E CDBG Operation and Repair of Foreclosed Property
19F Repayments of Section 108 Loan Principal
20 Planning
21A Program Administration
21B Indirect Costs
21C Public Information
21D Fair Housing Activities (subject to20%Admin,cap)
21E Submissions or Applications for Federal Programs
211 HOME CHDO Operating Expenses (subject to5%cap)
22 Unprogrammed Funds
tfi.
05F Substance Abuse Services
05G Battered and AbusedSpouses
05H Employment Training
051 Crime Awareness
05J Fair Housing Activities (if CDBG,then subject to 15%Cap)
05K Tenant/Landlord Counseling
05L Child Care Services
05M Health Services
05N Abused and Neglected Children
05O Mental Health Services
05P Screening for Lead Based Paint/Lead Hazards Poisoning
05Q Subsistence Payments
05R Homeownership Assistance (not direct)
05S Rental Housing Subsidies (if HOME,not part of 5%Admin cap)
05T Security Deposits (if HOME,not part of 5%Admin cap)
06 Interim Assistance
07 Urban Renewal Completion
08 Relocation
09 Loss ofRental Income
10 Removal of Architectural Barriers
11 PrivatelyOwned Facilities
12 Construction of Housing
13 Direct Homeownership Assistance
14A Rehab:Single-Unit Residential
14B Rehab:Multi-Unit Residential
14C PublicHousingModernization
14D Rehab:Other Publicy-Owned ResidentialBuildings
14E Rehab:Publiclyor Privately-Owned Commercial/Industrial
14F Energy Efficiency Improvements
14G Acquisition -ForRehabilitation
14H Rehabilitation Administration
141 Lead-Based/Lead Hazards Test/Abate
15 Code Enforcement
16A Residential Historic Preservation
16B Non-Residential historic Preservation
tfp
City of South Miami FY 1998
Facade Improvements
Scope of Services
National Objective:Low and Moderate Area Benefit
CDBG Eligible Activity and Regulation Subsection #:Commercial/Industrial Improvements
570.208(a)(4)Jobs Benefit
Title of Activity:Facade Improvement
Goal:Toimprovethe buildings ontheEastside of SW59thPlacebetweenSW68thandSW
69th Street.
Objective:Todesignandconstructafacadefor buildings ontheEastside of SW59thPlace
between SW 68th and SW 69th Street.
Action Steps;
a.Identify aqualified architect/engineer.
Timeline:January-February 1998
b.Complete preliminarydesignand presentations
Timeline:March-April 1998
c.CompleteandpresentfinaldesigntoreviewcommitteesandCityCommission
Timeline:May 1998
d.Meet OCED pre-bid requirements.
Timeline:April-June 1998
e.Prepare construction bid package.
Timeline:June 1998
f.Selectqualified contractor.
Timeline:July1998
g.Conduct preconstruction conference.
Timeline:July1998
h.Complete facade construction.
Timeline:July-December 1998
I.Contract completion/closeout
Timeline:December 1998
CITY OF SOUTH MIAMI
FACADE IMPROVEMENTS
CDBG REQUEST
Personnel
'04010 Project Manager $10,000.00
'04010 Secretary $2,000.00
@10%time
Sub-Total Salaries $12,000.00
Fringe Benefits
'04012 MICA/FICA @7.65%$918.00
Sub-Total Fringes $918.00
Total Personnel Services $12,918.00
Operating Expenses
'31530 Travel $200.00
'31611 Postage $50.00
Total Operating Expenses $250.00
Contractual Services
•20101 Audit $500.00
'31410 Legal Ads $1,000.00
'21411 Facade placement-contractor $75,332.00
'21411 Facade design $20,000.00
Contractual Total $96,832.00
Capital Outlay
'99031 renovations to building $20,000.00
exterior
Capital Outlay Total $20,000.00
Commodities
Commodities Total $0.00
QRAND TOTAL $130,000.00
.FORM 12
METRO-DADE COUNTYAFFIDAVITS
mdiuduals shall read carefully each affidavit to determine whether or not n pena.ns to this contract.
I.
L.Dennis Whitt .being first duly sworn state:
Affiant
The full legal name and business address of the person(s)or entity contracting or transacting business with Mcuo-Dade County are
(Post Office addresses arc not acceptable):
59-6000-431
Federal Employer Identification Number (If none.Social Security)
City of South Miami
Name ofEntity.Individual(s).Partners,or Corporation
Doing Business As (if same as above,leave blank)-^1436130SunsetDriveSouthMiamiFlorida33143
—cltv SSS ZipCode
Street Address *-"*
_I METRO-DADE COUNTY DISCLOSURE AFFIDAVIT (Sec.2*1of the County Code)
names and addresses are (Post Office addresses are not acceptable):
4/l/lMM OwnershipFullLegalNameAddress
HA =—*
%
(04
5*
2 The full legal names and business address of any other individual (other than subcontractors matenalmen.wtien Borers,or lenders,who have,or will have,any interest (legal,equitable beneficial or othem.se),n the
contract or business transaction with Dade County are (Post Office addresses are not acceptable):
ff/A
3 Anv oersbn who willfully rails to disclose the,information:required herein.><*J*hoImowiiigly discloses falseinforSninRegard,shall be punished by*afine of up to five hundred dollars ($500.00)or unpnsonmentin
the Countv jail for uptosixty (60)days or both.
FORM 13
II.METRO-DADE COUNTY EMPLOYMENT DISCLOSURE AFFIDAVIT (County Ordinance No.90-133.Amending
sec.2.8-1:Subsection (d)(2)of the County Code).
Except where precluded bv federal or State laws or regutotioi*each wntra*or business traitsa^which taratasfe expenditure of ten thousand dollars ($10,000)or more shall requtre the entity contracting orSTi«to disclose the following information.The foregoing disclosure requirements do not apply tocoZSswith'he United States or any department or agency thereof,the State or any pohucai subdivision or agency
thereoforany municipality ofthis State.
1.Does your firm have acollective bargaining agreement with its employees?—Yes —No
2.Does your firm provide paid health care benefits for its employees?—Yes —No
3.Provide acurrent breakdown(number of persons)of your firm's worn force and c^eismp as to race.iu^^
originand gender:
White:Males Females Asian:Males Females
Black:Males Females American Indian:Mates FemalesHispanics:ZI Males _Fema.es Aleut (Eskimo).—£"—££.Males Females M^es Females
HI.METRO-DADE COUNTY CRIMINAL RECORD AFFIDAVIT (Section 2-8.6 of the County Code)FORM 14
The individual or entity entering into acontract or receiving fimding from the County _hashas not as of the
date of this affidavit been convicted of a felony during the past ten (10)years.
A„ftffi~r director or executive of the entity entering into acontiart or recehruig fiJBding ftom has^^no^thf^^
IV METRO-DADE COUNTY CUBA AFFTOAm (Countyltesolution R-656-93)FORM 15
Act of 1992.
I0<J
FORM 16
V METRO-DADE EMPLOYMENT DRUG-FREE WORKPLACE AFFIDAVIT (County Ordinance No.92-15 codified
as Section 2-8.1.2 of the County Code)
That incompliancewith Ordinance No.92-15 oftheCodeofMetropolitan Dade County.Florida,the abovenamed
person orentityisprovidingadrug-free workplace.Awritten statement toeach employee shall inform the employee
about:
I.danger of drugabuseintheworkplace
~2.thefirm'spolicy of maintaining a drug-free environment atall workplaces
3.availability of dnig counseling,rehab^r •
4.penalties thatmaybe imposed uponemployeesfordrugabuseviolations.....
The person orentityshallalso require an employee tosignastatementasacondition of employmentthatthe employee
willabidebythetermsandnotifytheemployerofanycriminaldrugconvictionoccurringnolaterthanfive(5)days
afterreceivingnoticeofsuchconvictionand impose appropriate personnel actionagainstthe employee uptoand
includingtermination.
*}
Compliance with OrdinanceNo.92-15 may bewaived if thespecial characteristics of theproductorserviceoffered by
thepersonorentitymakeit necessary fortheoperationoftheCountyorforthe health,safety,welfare,economic
benefitsand well-being of thepublic.Contractsinvolving funding whichisprovidedinwholeorinpartbytheUnited
StatesortheState of Florida shall beexemptedfromtheprovisionsofthis ordinance inthoseinstanceswherethose
provisions are in conflict with the requirements of those governmental entities.FORM 17
VI.METRO-DADE EMPLOYMENT FAMILY LEAVE AFFIDAVIT (County Ordinance No.142-91 codifiedasSection
i 1A-29 a.SSfl of the County Code)
ThatincompliancewithOrdinanceNo.142-91 of the Codeof Metropolitan DadeCounty.Florida,anemployer with
fifty (50)ormoreemployeesworkinginDadeCountyforeachworkingdayduringeachof twenty (20)ormore
calendar work weeks,shall provide the following information in compliance with all items in the aforementioned
ordinance:
Anemployeewhohasworkedfortheabovefirmatleastone(1)yearshallbeentitledtoninety(90)days of family
leaveduringanytwenty-four(24)month period,formedical reasons:forthebirthoradoptionofa child,orforthecare
ofa child,spouseorothercloserelativewhohasaserioushealthconditionwithoutriskofterminationof employment
or employer retaliation.
The foregoing requirements shall not pertain to contracts withthe United States orany department or agency thereof.
orthe State of Florida orany political subdivision or agency thereof.It shall,however,pertain to municipalities ofthis
State.
FORM 18
VH.DISABILITY NON-DISCRIMINATION AFFIDAVIT (County Resolution R-385-95)
That the above named firm,corporation or organization isin compliance with and agrees to continue to comply with.
*""""dha aSSUre thatany subcontractor,or third ^ty contractor under this project complies with all applic3ble-»qu!remer.ts
ofthe laws listed below including,but not limited to.those provisions pertaining to employment provision of programs
and services,transportation,communications,access to facilities,renovations,and new construction in the following
laws:The Americans with Disabilities Act of 1990 (ADA).Pub.L.101-336.104 Stat 327.42 U.S.C.12101-12213 and
47U.S.C.Sections 225 and 611 including Title I.Employment:Title II.Public Services:Title III.Public
Accommodations and Services Operated by Private Entities:Title IV.Telecommunications:and Title V,Miscellaneous
Provisions:The Rehabilitation Actof 1973.29 U.S.C.Section 794.The Federal TransitActas amended 49 U.S.C.
Section 1612:The Fair Housing Act as amended.42 U.S.C.Section 3601-3631.The foregoing requirements shall not
pertain to contracts with the United States or any department or agency thereof,the State or any political subdivision or
agency thereof orany municipality of thisState.
(06
yu
FORM 19
_VUI.METRO-DADE COUNTY REGARDING DELINQUENT AND CURRENTLY DUE -FOBS OR TAXES (Sec.
2-8.1(c)ofthe County Code)
Pxctot for small purchase orders and sole source contracts,that above named firm,corporation,organization orS^d^ring^^nstcfbusiness or enter into acontract with the County-^<»**£££*^nirdue fees or taxes -including but not limited to real and property taxes,utility-taxes and occupationalS-whS are cXaedTnthe norma,course by the Dade County Tax Collector as »*ll as Dade CountyS^P^^,?31w«registeredl in thename of the firm,corporation,organization or individual have
beenoaicL ..—**..-r'./....•t-t.tv."-r .•-/•••:a-^v.v .............
Ihave carefully read this entire four (4)page document entitled,"Metro-Dade ^AtS^!^indicated by an "X"all affidavits that pertain to this contract and have indicated by an N/A all affidavits
not pertain tothis contract.
.*•
19 by.
(Signature of Affiant)
SUBSCRIBED AND SWORN TO (or affirmed)before me this.
as identification.
(Type of Identification)
(Signature of Notary)
(Print or Stamp of Notary)
Notary Public •State of.
(State)
imSvtTi-»t-•
101
(Date)
day of.
He/She is personally known to me or has
(SerialNumber)
(Expiration Date)
Notary Seal
FORM 19A
mS FORM MOST BE «««»£«£?™"^^°'A"^"BUC """^omOAL AUTHORIZED.TO ADMIKISTSR OATHS.
Metropolitan Dade County •
L Ti*twot««mtmeattofW>mlaedlo ipHnt nine of «b«pobUe entity]
w.T..nMW^^tt-Citv Manager
**[print'tttfldauSi mm «»4 «dej
tor City of South Miami
[print name of entity •omnitanf
s who*batmen address »
6130 Sunset Drive
5.
South Miami,FL 33143
(If «.«dV ta.•>FEW.I«W.«*SOCW fed*W-Mr -«*I—-I -P*«*
rZe^TTt.-public en**crime-a.*^*^«g£^^iwuta of any ««te^T federal tew by •penou ^J^J?(iSo«SwoS«ittte or of the United££e»wiuSy public eater or ^«^"£?£^S^iSSS^^A to any pobUcStates,mdudlat ^r^uSSSvSntf wTESS otof tS SXoState,indTn^Mng mmSS0^^?^!^^^'£$£,or material mi^eproe.t.uon.
I«dent»dthat.«nvic*d-*a«*£?«fuflt or acouvWooof apubUc «2^ro^2t^toltomSt Trtafomation after July 1,SSf«.Sff.TS SS^^At^Wa of guilty or nolo contendere.
I understand that an -affiliate'as denned la *nwh7SlWWn*UMSUtt*^'
L A predecease*c*iue»eiieTO<«!^
2.An entity under taecontrol of nay natural P^»™JLS5«tTadute those officers,directors,Sheiha?SSn^owicted of a poblte eatlty crime^Tbe mm ^^^^JbS:pMaw«^^of
-SmMFVIM*.a*"*^*01*1^^»-inotner person,
•geois who are taive in aamtemeiit o(«n Mrty.
M
FORM19A
)
Basedoninformationandbelief,thecutementwhichIhave—«»*•*<<belowfatrwinrelationtotheentity
fubmittlngthisjwornstatement,(Indicatewhichstatementapplies.}
Neithertheentitysubmittingthisswornstatement,noranyoflaofficers,directors,executives,
partners,shareholders,employees,members,oragentswhoareactiveinthemanagementoftheentity,nor
anyaffiliateoftheentityhasbeenchargedwithandconvictedofapublicentitycrimesubsequentto'Jury
1.1989.
____Theentitysubmittingthisswornstatement,oroneormoreofItsofficers;directors,executives,
partners,shareholders,employees,members,oragentswhoareactiveinthemanagementoftheentity,or
anaffiliateoftheentityhasbeenchargedwithandconvictedofapublicentitycrimesubsequenttoJury
1,1989.
Theentitysubmittingthisswornstatement,oroneormoreoftotofficers,directors,executives,
partners,shareholders,employees,members,oragentswhoareactivemthemanagementoftheentity,or
anaffiliateoftheentityhasbeenchargedwithandconvictedofapubliceatitycrimesubsequenttoJury
1,1989.However,therehasbeenasubsequentproceedingbeforeaHearingOfficeroftheStateofFlorida,
DivisionofAdmirrigativeHearingsandtheFinalOrderenteredbytheHearingOfficerdeterminedthat
itwasnotinthepublicinteresttoplacetheentitysubmittingthisswornstatementontheconvictedvendor
list[attach•copyofthefinalorder]
IUNDERSTANDTHATTHESUBMISSIONOFTHISFORMTOTHECONTRACTINGOFFICERFORTHE
PUBUCENTITYIDENTIFEEDINPARAGRAPHI(ONE)ABOVEISFORTHATPUBUCENTITYONLYAND,
THATTHISFORMISVALIDTHROUGHDECEMBER31OFTHECALENDARYEARINWHICHITISFILED.
IALSOUNDERSTANDTHATIAMREQUIREDTOINFORMTHEPUBUCENTITYPRIORTOENTERING
INTOACONTRACTINEXCESSOFTHETHRESHOLDAMOUNTPROVIDEDINSECTION287.017,FLORIDA
STATUTESFORCATEGORYTWOOFANYCHANGEINTHEDEFORMATIONCONDONEDINTHISFORM.
Off6UA^^/S/Wf,
[signature]
Sworntoandsubscribedbeforemethis______dayof.19.
Personallyknown
ORProducedidentificationNotaryPublic-Stateof.
---Mrffwwmfrtirmexpires.
(Typeofidentification)
FormPUR7068(Rev.06718/92)
(Printedtypedorstamped
commissionednameofnotarypublic)